Pituitary-dependent Cushing’s syndrome (Cushing’s disease) is rare with 1–2 new cases per million of the population per year.1 The majority of cases result from a pituitary corticotrophin microadenoma. A macroadenoma is very unusual and may account for between 4% and 10% of Cushing’s disease.2–5 Pituitary apoplexy occurs in 10–17% of all histologically and surgically examined pituitary tumours,6,7 and as an acute presentation of a pituitary adenoma only occurs in ∼5% of cases.8 These adenomas are typically non-functioning, somatotroph or prolactinomas in nature. Apoplexy is an uncommon event in corticotrophin-producing adenomas.9 Reports of apoplexy in corticotrophin microadenomas are documented in the literature,9,10 however descriptions of acute spontaneous apoplexy into a corticotrophin macroadenoma are rare.11 A 62-year-old woman recently diagnosed with type 2 diabetes and hypertension presented to the accident and emergency department of her local hospital, with a sudden frontal headache associated with visual field disturbance and vomiting. Examination showed her to be conscious …
